A Nomogram for Predicting ADHD and ASD in Child and Adolescent Mental Health Services (CAMHS).

Objectives: To enhance the early detection of Attention Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) by leveraging clinical variables collected at child and adolescent mental health services (CAMHS). Methods: This study included children diagnosed with ADHD and/or ASD (n = 857). Three logistic regression models were developed to predict the presence of ADHD, its subtypes, and ASD. The analysis began with univariate logistic regression, followed by a multicollinearity diagnostic. A backward logistic regression selection strategy was then employed to retain variables with p < 0.05. Ethical approval was obtained from the local ethics committee. The models' internal validity was evaluated based on their calibration and discriminative abilities. Results: The study produced models that are well-calibrated and validated for predicting ADHD (incorporating variables such as physical activity, history of bone fractures, and admissions to pediatric/psychiatric services) and ASD (including disability, gender, special education needs, and Axis V diagnoses, among others). Conclusions: Clinical variables can play a significant role in enhancing the early identification of ADHD and ASD.

Physiological ICSI (PICSI) vs. Conventional ICSI in Couples with Male Factor: A Systematic Review.

OBJECTIVES: To determine the efficacy of the physiological ICSI technique (PICSI) vs. conventional ICSI in the prognosis of couples, with respect to the following outcome measures: live births, clinical pregnancy, implantation, embryo quality, fertilization and miscarriage rates. METHODS: A systematic review of the literature, extracting raw data and performing data analysis. Patient(s): Couples with the male factor, who were subjected to in-vitro fertilization. Main Outcome Measures: rates of live births, clinical pregnancy, implantation, embryo quality, fertilization and miscarriage. RESULTS: In the systematic search, we found 2,918 studies and an additional study from other sources; only two studies fulfilled the inclusion criteria for this systematic review. The rates of live births, clinical pregnancy, implantation, embryo quality, fertilization and miscarriage were similar for both groups. CONCLUSION: There is no statistically significant difference between PICSI vs. ICSI, for any of the outcomes analyzed in this study. Enough information is still not available to prove the efficacy of the PICSI technique over ICSI in couples with male factor.

Outdoor air pollution and human infertility: a systematic review.

Air pollution is a current research priority because of its adverse effects on human health, including on fertility. However, the mechanisms through which air pollution impairs fertility remain unclear. In this article, we perform a systematic review to evaluate currently available evidence on the impact of air pollution on fertility in humans. Several studies have assessed the impact of air pollutants on the general population, and have found reduced fertility rates and increased risk of miscarriage. In subfertile patients, women exposed to higher concentrations of air pollutants while undergoing IVF showed lower live birth rates and higher rates of miscarriage. After exposure to similar levels of air pollutants, comparable results have been found regardless of the mode of conception (IVF versus spontaneous conception), suggesting that infertile women are not more susceptible to the effects of pollutants than the general population. In addition, previous studies have not observed impaired embryo quality after exposure to air pollution, although evidence for this question is sparse.

Impact of air pollution on fertility: a systematic review.

Air pollution has gained considerable interest because of the multiple adverse effects reported on human health, although its impact on fertility remains unclear. A systematic search was performed to evaluate the impact of air pollutants on fertility. Controlled trials and observational studies assessing animal model and epidemiological model were included. Occupational exposure and semen quality studies were not considered. Outcomes of interest included live birth, miscarriage, clinical pregnancy, implantation, and embryo quality. Ten studies were included and divided into two groups: animal studies and human epidemiological studies including the general population as well as women undergoing in vitro fertilization and embryo transfer (IVF/ET). Results from this systematic review suggest a significant impact of air pollution on miscarriage and clinical pregnancy rates in the general population, whereas among subfertile patients certain air pollutants seem to exert a greater impact on fertility outcomes, including miscarriage and live birth rates. Besides, studies in mammals observed a clear detrimental effect on fertility outcomes associated to air pollutants at high concentration. The lack of prospective studies evaluating the effect of air pollution exposure in terms of live birth constitutes an important limitation in this review. Thus, further studies are needed to confirm these findings.

The effects of letrozole on ovarian stimulation for fertility preservation in cancer-affected women.

Survival rates for fertile women with cancer have increased significantly, lending importance to considering the possibility of motherhood after cancer. This study was a retrospective analysis of a prospective database comparing two groups of patients who underwent fertility preservation after being diagnosed with either breast cancer or a non-hormone-dependent cancer between 2009 and 2011. Nineteen oncology patients were included in the study. The objective was to assess the efficacy of ovarian stimulation with aromatase inhibitors versus a standard antagonist protocol. This study sought to quantify oestradiol concentrations in patients receiving letrozole and to determine the length of time between diagnosis of malignancy and onset of fertility preservation. Number of mature oocytes retrieved in the non-hormone-dependent cancer group was comparable to that in the breast cancer group (15.4±8.19 versus 16.3±7.31). Oestradiol concentrations were higher for patients with non-hormone-dependent cancer (1666.4±739.42 pg/ml versus 829±551.11 pg/ml, P=0.006). There were no differences between the groups in the length of time between diagnosis and fertility preservation (17.4±4.93 versus 16.4±1.74 days). Oestradiol concentrations of breast cancer patients on the letrozole protocol remained much lower than those of patients on the antagonist protocol.

The Value of Hysterosalpingography following Medical Treatment with Methotrexate for Ectopic Pregnancy.

After an ectopic pregnancy (EP) fertility decreases, mostly due to tubal factor. Hysterosalpingography (HSG) is the most cost-effective tool for tubal patency assessment. Objective. To evaluate the usefulness of a HSG after a medical treatment for an EP, in order to counsel women on the most appropriate way to conceive future pregnancies. Methods. Between 1998 and 2008, 144 patients were submitted to medical treatment for an EP and performed HSG 3 months after the event. Results. 72.2% of normal HSG, 18.8% with unilateral obstruction, 6.3% tubal patency with defect, and 2.8% bilateral obstruction. Conclusion. Routine HSG following medical treatment for an EP does not seem necessary, as it does not change the initial management in 97.2% of the cases, but might be considered in selected risk cases, permitting timely referral of patients to in vitro fertilization.

De novo urgency after tension-free vaginal tape versus transobturator tape procedure for stress urinary incontinence.

OBJECTIVE: To determine the frequency of de novo urgency after tension-free vaginal tape (TVT) compared with the transobturator tape (TOT) procedure in women with stress urinary incontinence (SUI). STUDY DESIGN: Prospective study of all consecutive women with urodynamically confirmed SUI undergoing anti-incontinence surgery between January 2000 and January 2008. All procedures were performed by experienced urogynaecologists well trained in TVT and TOT surgery. Assessments were carried out at 1, 6, 12 and, 36 months after surgery. RESULTS: The study population included 366 women (mean age 59.5 years), 243 in the TVT group and 123 in the TOT group. The groups were similar in terms of demographics, preoperative data, and cure rates. De novo urgency occurred in 13.4% of patients at 6 months after surgery, in 19.3% at 12 months, and in 22.1% at 36 months. De novo urgency was significantly more frequent in the TVT group than in the TOT group at 12 (22.2% vs 11.2%, P=0.025), 24 (24.8% vs 12.3%, P=0.033), and 36 (0% vs 24.7%, P=0.034) months. Cure rates were similar in both groups. The final adjusted cure rate was 87.3% (319/366). CONCLUSION: Treatment of SUI using the TOT procedure was associated with a lower rate of de novo urgency.

Accidental introduction of a contraceptive vaginal ring into the urinary bladder.

INTRODUCTION AND HYPOTHESIS: A case of inadvertent self-introduction into the urethra of a folded contraceptive vaginal ring (NuvaRing) in a 22-year-old woman is reported. METHODS: The patient presented with lower urinary tract symptoms, including dysuria, urgency, and terminal hematuria, that appeared a few minutes after insertion of the device. RESULTS: The diagnosis was made by abdominal echography. The abdominal pelvic computed tomography scan confirmed the intravesical presence of the unfolded ring. CONCLUSIONS: Vaginal contraceptive rings should be added to the list of potential intravesical foreign bodies causing lower urinary tract symptoms.

Periurethral granuloma following injection with dextranomer/hyaluronic acid copolymer for stress urinary incontinence.

Periurethral injection of bulk-enhancing agents provides a simpler and cost-effective therapeutic approach for stress incontinence in women. We report a case of periurethral granuloma secondary to dextranomer/hyaluronic acid (Dx/HA) copolymer injection. A 73-year-old woman with history of radiotherapy for cervical carcinoma at the age of 55 presented with stress urinary incontinence. She underwent periurethral injection of Dx/HA copolymer, and incontinence was resolved. At 4 months postoperatively, a 3-4 cm noninflammatory painless mass in the external genitalia was noted. Cystic images compatible with urethral diverticula were seen in the magnetic resonance imaging scan, but voiding cystourethrography was unrevealing. Transvaginal tumor puncture yielded abundant creamy material, the culture of which was negative. Microscopic examination revealed refractile foreign material surrounded by foreign body giant cells. Surgical debridement of the granuloma using a cold scalpel was performed. Stress urinary incontinence recurred but resolved spontaneously within 1 month. One year later, the patient continues to be asymptomatic.